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Apply On-line - Wireless
Your Details
Title (Mr/Mrs etc):
First Name:
Surname:
Work No:
Mobile No:
Phone Number for ADSL Line:
Street Address for ADSL Line location:
Suburb:
Postcode:
State:
Contact Email Address:
Registered Company Name: (if applicable)
ABN:
Connection Speed Required (256K/512K/1500K):
Do you require an ADSL modem: YES NO
Do you require a Kangaroo Tech email address?
If yes enter it here		 @kangarootech.com.au
Please enter the name of your Kangaroo Tech Account Manager (if known):
NOTE:- before you submit this order, be sure that you have read our terms and conditions of order. To review the terms and conditions please click here
If you are an organisation looking for advanced Internet services (email hosting, web hosting, domain services, etc) please list your requirements here and our trained service representatives will contact you soon.
Please call us on 0416 229 228 or we will contact you for full details of all additional services

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